The pre-ablation triglyceride-glucose index predicts late recurrence of atrial fibrillation after radiofrequency ablation in non-diabetic adults

Abstract

Background Current prognostic risk scoring systems and biomarkers are routinely used as non-invasive methods for assessing late recurrence of atrial fibrillation (AF) in patients who have undergone radiofrequency catheter ablation (RFCA). This study aimed to investigate the predictive value of the triglyceride-glucose (TyG) index for late AF recurrence after RFCA in non-diabetic patients. Methods In total, 275 patients with AF who underwent RFCA at the Fuwai hospital (Beijing, China) between January 2016 and December 2018 were enrolled in this study. During follow up, patients were divided into late and non-late AF recurrence groups, based on whether they had experienced late AF recurrence determined by electrocardiography (ECG) examine or 48 h Holter monitoring. The TyG index was calculated using the following equation: ln [fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2]. Results During a median follow-up of 26.1 months, late AF recurrence event rates significantly increased in the highest TyG index tertile group (tertile 3) compared to the lowest group (tertile 1) (54% versus 12%, respectively; p < 0.001). The mean TyG index was higher in the late AF recurrence group compared to the non- late AF recurrence group (9.42 ± 0.6 versus 8.68 ± 0.70, respectively; p < 0.001). On multivariate Cox regression analysis, the pre-ablation TyG index was an independent risk factor for late recurrence of AF after RFCA (hazard ratio [HR] 2.015 [95% confidence interval (CI): 1.408–4.117]; p = 0.009). Receiver operating characteristic (ROC) curve analysis revealed that TyG index was a significant predictor of late AF recurrence after RFCA, with an area under the ROC curve (AUC) of 0.737 (95% CI: 0.657–0.816; p < 0.001). In addition, the AUC of left atrial diameter (LAD) was 0.780 (95%CI: 0.703–0.857, p < 0.001). Finally, the TyG index positively correlated with LAD (r = 0.133, p = 0.027), high sensitivity C-reactive protein (r = 0.132, p = 0.028) and N-terminal pro B-type natriuretic peptide (r = 0.291, p < 0.001) levels. Conclusions An elevated pre-ablation TyG index was associated with an increased risk of late AF recurrence after RFCA in non-diabetic patients. The TyG index may be potentially useful as a novel biomarker for the risk stratification of late AF recurrence in non-diabetic patients.

Association between triglyceride-glucose index and atrial fibrillation: A retrospective observational study

“…Moreover, since different cohorts may lead to the controversial results, an additional subgroup analysis of our study compared the difference between diabetic and non-diabetic population. Similar to what published researches reported (26,29,30), the present study showed the elevated TyG index was associated with AF in non-diabetic, whereas a role between TyG index with AF has not been observed in diabetic subjects. Lee et al have identified the non-linear relationship between IR and the risk of AF, and the AF development increased at the HOMA-IR levels approximately between 1-2.5, and then plateaued afterwards (6).…”

“…found the baseline IR contributes to the long-term risk of incident AF in a community-based non-diabetes population ( 6 ). And a retrospective study of non-diabetic patients who have undergone radiofrequency catheter ablation (RFCA) showed the elevated TyG index was associated with an increased risk of late AF recurrence ( 26 ). Data from animal experiment also shows the IR mice were highly vulnerable to AF due to impaired glucose transport in the atria ( 27 ).…”

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

“…Pulmonary vein isolation (PVI) is an essential approach, and its electric isolation from the left atrium (LA) achieves a high rate of freedom from AF. However, AF recurrence often occurs, which is not only due to pulmonary vein (PV) reconnection but also an additional arrhythmogenic atrium responsible for AF maintenance [1,2]. Atrial substrate remodeling progresses with aging, the persistence of AF, heart failure, and cardiovascular risk factors [3][4][5].…”

Non-insulin-based insulin resistance indexes in predicting atrial fibrillation recurrence following ablation: a retrospective study

“…Notably, this study demonstrated that METS-IR could predict AF recurrence, with the higher predictive value compared with TyG index and TG/HDL-C ratio. Recent research showed that an elevated pre-ablation TyG index is associated with an increased risk of AF recurrence after RFCA in non-diabetic patients [ 35 ]. We demonstrated that TyG index was an independent risk factor for recurrence after AF ablation, both in diabetic and non-diabetic patients.…”

“…It has been shown that IR induces structural remodelling of the atria and abnormal intracellular calcium homeostasis [ 46 ]. Increased oxidative stress and inflammation were associated with impaired IR and insulin secretion, resulting in atrial electrical remodeling, LA fibrosis and LA low-pressure area, which may be the main components of the pathophysiology of AF [ 35 , 47 ]. Most components of IR, such as abnormal glucose tolerance, obesity, and abnormal lipid levels, have been found to have a cumulative effect on the risk of AF progression, which may be associated with AF recurrence after RFCA.…”